Regulators to double down on QAPI after government report on adverse events in post-acute care

The Centers for Medicare & Medicaid Services sees the upcoming Quality Assurance & Performance Improvement guidelines, not harsher penalties, as the way to reduce adverse events in post-acute care, officials said on an Open Door Forum call Thursday.

More than one in five Medicare beneficiaries who receive skilled care after a hospitalization experience an adverse event, according to a report released this week by the Health and Human Services Office of the Inspector General. The study was “well done” in terms of its methodology and scope of review, CMS officials said on Thursday's call. They emphasized that the agency worked closely with the OIG prior to the report's release and will continue to do so in order to reduce these incidents.

Still, when pressed by a caller about how they intend to “crack down” on adverse events, the CMS representatives said this is not the approach they will take. Although they discuss adverse events with surveyors who go into post-acute facilities, survey citations will not be the “primary source” for addressing these incidents, they said. Instead, they intend to focus on assisting providers in implementing quality improvement initiatives, specifically through QAPI.

The Medicare agency has been providing “technical assistance” to nursing homes in the last two years as the official promulgation of QAPI rules has been in development, officials noted. They pointed to resources available online, such as instruction on how to conduct a root cause analysis.

However, they still did not say when the highly anticipated and much-delayed QAPI regulations will be formally promulgated, noting only that the regulations will contain more “prescriptive requirements.”

They were more specific when discussing updates to the Minimum Data Set 3.0 Resident Assessment Instrument manual. Providers can expect a single update to the manual this year, which will be released in the fall, said Cheryl Wiseman, of the CMS Quality Measurement and Health Assessment Group.

New MDS 3.0 training videos will be available online in the near future, Wiseman also noted.